Medicine and Science from The BMJ

Overdiagnosis means different things to different people. Stacy Carter, associate professor at the Centre for Values, Ethics and the Law in Medicine at the University of Sydney argues that we should use a broad term such as too much medicine for advocacy and develop precise, case by case definitions of overdiagnosis for research and clinical purposes. Read the full analysis article: http://www.bmj.com/content/350/bmj.h869 For the full overdiagnosis digital edition: http://www.bmj.com/specialties/digital-theme-issue-overdiagnosis

In this podcast Alexandra Barratt, professor of public health at the University of Sydney, discusses how questions about overdiagnosis in breast cancer screening programmes were first raised 45 years ago, and why it has taken so long for the concept to become mainstream. Read her full analysis: http://www.bmj.com/content/350/bmj.h867

The BMJ held a breakfast roundtable at the annual health policy summit held by the Nuffield Trust think tank to explore some of the key policy discussions that took place during the ​proceeding day. These included NHS England chief executive Simon Stevens' five year plan, whether politics can be removed from the NHS, and what the creation of a central unit to coordinate care for Manchester means for the rest of the ​NHS in England. Chaired by Fiona Godlee, editor in chief of The BMJ, the particpants were: Richard Jones - Clinical director of the Wessex Cardiovascular Strategic Clinical Network Suzie Bailey - Development director at health service regulator Monitor Jonathan Michael​ - ​chief executive of Oxford University Hospital NHS Trust Steve Field - Chief inspector of general practice for the Care Quality Commission Nigel Edwards - Chief executive of The Nuffield Trust Jeremy Taylor - Chief executive of health and care charity National Voices Massoud Fouladi - Chief medical officer of Circle Partnership Rebecca Rosen - GP and clinical commissioner of Greenwich Clinical Commissioning Group, London Jennifer Dixon - Chief executive of the Health Foundation

As the level of alcohol consumption goes up, so the risk of physical, psychological, and social problems increases. In this podcast we’re joined by Ed Day, consultant addiction psychiatrist at Kings College London, Alex Copello, professor of addiction research at the University of Birmingham, and Martyn Hull, GP with a special interest in substance misuse at the Ridgacre Medical Centres in Birmingham. They discuss practical aspects of the assessment and treatment of alcohol use disorders from the perspective of the non-specialist hospital doctor or general practitioner. Read the full clinical review: http://www.bmj.com/content/350/bmj.h715

Jackie Applebee is a GP in Tower Hamlets in London, and is concerned that the way the GP funding formula is working doesn't take account of the earlier health needs of people in deprived areas. For more about the Tower Hamlets Save Our Surgery campaign, visit their facebook page https://www.facebook.com/SaveOurGPsurgeries BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com. If you would like to contribute to this collection, please email a brief audio recording to voices@bmj.com or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Michelle Sinclar, a GP in Hampshire who is concerned that GP premises aren't fit for purpose and limit her ability to provide fully rounded patient care. BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com. If you would like to contribute to this collection, please email a brief audio recording to voices@bmj.com or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Mark Folman, a GP in Nottinghamshire, is concerned that more and more work, with more and more patients, means less time with those who really need him. BMJ Voices is a collection of readers’ experiences of working in the NHS. For this, The BMJ is seeking short audio submissions from UK listeners. These submissions will be published on thebmj.com. If you would like to contribute to this collection, please email a brief audio recording to voices@bmj.com or phone +44 (20) 3058 7427 and tell us what your main concern for the NHS is. Please include your name, job title, and place of work.

Participants in our discussion on person centred care in January agreed that a change in culture and better use of technology could benefit both patients and doctors. At the roundtable: Fiona Godlee (chair), editor in chief, The BMJ Tessa Richards, senior editor, patient partnership, The BMJ Rosamund Snow, patient editor, The BMJ Navjoyt Ladher, clinical editor, The BMJ Angela Coulter, director of global initiatives, Informed Medical Decisions Foundation (www.informedmedicaldecisions.org) Paul Wicks, vice president of innovation, PatientsLikeMe (www.patientslikeme.com) Michael Seres, founder, 11 Health (www.11health.com) Alf Collins, clinical associate in person centred care, Health Foundation (www.health.org.uk) Jeremy Taylor, chief executive, National Voices (www.nationalvoices.org.uk) Dave deBronkart, cochair, Society for Participatory Medicine (www.participatorymedicine.org) Amir Hannan, general practitioner and member of clinical commissioning group board Alexander Silverstein, past president, International Diabetes Federation’s young leaders in diabetes project Paul Hodgkin, founder, Patient Opinion (www.patientopinion.org.uk) Ben Mearns, consultant in acute care and elderly medicine, Surrey and Sussex Healthcare NHS Trust Sara Riggare, PhD student in health informatics, Karolinska Institute Rupert Whitaker, founder, Tuke Institute (www.tukeinstitute.org) Stephen Leyshon (observer), DNV Healthcare

In our accompanying roundtable discussion,we hear views from a group of patients and clinicians based largely in the UK on the actions required  to advance  progress towards providing patient centred care. To extend the conversation we talked to members of the BMJ's international patient advisory panel and other patient advocates - and what follows are short clips of hour long conversations with people in the US, Europe, India, Equador and Uganda. While the quality of the recordings vary there is no mistaking the passion of these advocates to improve care for fellow patients and the barriers which need to be overcome to make it happen. Taking part in this discussion in order are: Dominck Frosch,associate professor, University of California Maggie Breslin US designer, researcher and writer Matthew Maleska, designer, Patient Revolution Project Cristin Lind, patient advocate, Rare Diseases Sweden Corine Jansen, cheif listening officer, JoConnect Jonas Gonseth, chief executive, Gaerente en Hospital de Especialidades Guayaquil, Equador Rakhal Gaitonde chair, community advisory board of the National Institute for Research on Tuberculosis Robinah Alambuya, president of the Pan African Network of People with Psychosocial Disabilities, Uganda Daniel Iga Mwesigwa, executive medical director, Mwesigwa Medical Centre, Uganda

Karen Grépin, assistant professor of global health policy at New York University, has been examining the pledges made by the international community to help fight the ebola virus outbreak - was it really too little, too late? Read her full analysis: http://www.bmj.com/content/350/bmj.h376